Provider Demographics
NPI:1346658317
Name:MANTONI MOBILE DENTISTRY
Entity Type:Organization
Organization Name:MANTONI MOBILE DENTISTRY
Other - Org Name:THE MOBILE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-587-7406
Mailing Address - Street 1:8757 GEORGIA AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3737
Mailing Address - Country:US
Mailing Address - Phone:301-587-7406
Mailing Address - Fax:
Practice Address - Street 1:8757 GEORGIA AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3737
Practice Address - Country:US
Practice Address - Phone:301-587-7406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty